Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

If we are going to be successful in improving our healthcare system, we are going to have to make a difference in the quality of healthcare provided, access to care, health literacy on the part of consumers of care; and we will have to make it easier to live a healthier lifestyle for those most at risk. But how can we do this and where do we start?

Any effort that seeks to address healthcare quality and costs, both categories that seem to top the chart for both consumers, payers, political leaders, and policy makers, must address the continuum of prevention, intervention, followup, evaluation, and implementation of findings. The process of true healthcare reform must begin with each individual and the social and economic context in which he or she must navigate (health literacy) to achieve an optimal health lifestyle. The most significant challenge for a culturally diverse society like ours in the area of supporting and addressing lifestyle with the goal of improving health is communication. In the area of healthcare this means optimal interpersonal health communication between provider and service recipient. What do patients who experience communication dissonance in the healthcare encounter think of the physician – patient encounter? That’s where we need to begin.

“Patient-reported experiences of care are an important focus in health disparities research. This study explored the association of patient-reported experiences of care with race and acculturation status in a primary care setting. 881 adult patients (African-American 34%; Hispanic–classified as unacculturated or biculturated–31%; Caucasian 33%; missing race 2%), in outpatient Family Medicine clinics, completed a written survey in Spanish or English. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CAG) Survey Adult Primary Care instrument was used for experiences of care and Short Form-12 survey for health status. Controlling for other variables, race and acculturation were significantly associated with several CAG subscales. Hispanic patients gave significantly higher ratings for care experiences and expressed greater interest in shared decision making. Selected patient-reported measures of care are associated with patients’ race and acculturation status (for Hispanic patients). We discuss implications for both provision and measurement of quality care.”

When you visit your doctor does (s)he look happy? At the end of the day healthcare is a one on one personal experience. All the insurance coverage or fancy machines in the world won’t improve medical care if the doctor patient relationship is not optimal.

So what is our healthcare system doing to address physician happiness? The Gallup organization took a closer look at hospitals, one place where physician practice is defined and sustained–for better or for worse…

“When doctors are frustrated, patient care and hospital revenues suffer. Heres how hospitals can engage their physicians — and make a positive impact on patients and the bottom line.”

Historically, if you have a job, although you may barely have enough to pay rent and feed your family, you cannot qualify for help with the high cost of healthcare for your growing family.

The expansion of Medicaid means that people who struggle in low paying jobs will be able to qualify for healthcare at reasonable rates for them or their employers under the new expansion made possible by the current ACA healthcare reform (Obama Care).

Hispanics are the nation’s largest growing majority and are increasingly becoming the largest group in many of the nation’s cities and states. Ironically, a disproportionate majority of the people who qualify for Medicaid expansion, will be Hispanics/Latinos, who tend to work at low paying/low benefit jobs that do not currently provide benefits, much less health benefits, for their growing families. Obama care offers incentives and eventually legal mandates for employers and individuals to avail themselves of local health care access opportunities. States must step up to the plate and help create and/or support these local healthcare access opportunities. The Federal government must be held accountable, though, to continue to support these efforts and not leave the states on their own–especially in these times of recession and low state tax collection due to a recessionary economy.

What is at stake is the healthcare coverage that is needed by millions of mothers and children who will otherwise be punished for taking low paying, low benefit jobs. Hispanics/Latinos are not rewarded by our society for having high labor force participation rates. The states need to take a long look at the implementation for the ACA and see it as an opportunity to invest in today’s young Latinos/Hispanics who are becoming an important part of the American mosaic and our future.

“As states wrap up legislative sessions and make decisions about whether to implement the Medicaid expansion included in the Affordable Care Act (ACA), this new analysis highlights the implications of these decisions for coverage, state finances and providers. As of July 2013, 24 states were moving forward with the Medicaid expansion, 21 states were not moving forward with the expansion and debate was on-going in the remaining 6 states. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave many more uninsured; these states would also forgo billions in federal funds.”

Women’s health issues are intrinsically tied to men’s health. This is evident in recent vaccine recommendations.

Vaccination rates have slowly been increasing for the two vaccines that protect young people against infection by certain strains of the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States.1 The vaccines were originally recommended only for girls and young women and were subsequently broadened to include the recommendations for boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines.

HPV and Cancer

There are more than 100 strains of HPV, and while most cases of HPV infection usually resolve on their own, there are more than 40 strains that can cause cancer. Overall, HPV is related to almost 100% of cervical cancer cases.2 Cervical cancer is the main concern with HPV, but the disease is also known to cause oral, anal, vulvar, vaginal and penile cancers, as well as genital warts.1

HPV infection in the U.S. is widespread; there are more than 6 million new infections annually, and it is estimated that 50% of sexually active men and women will get HPV at some point in their lives.3 The highest rates are seen among women ages 20-24, with a prevalence rate of 45%.4

In the U.S., it is estimated that over 12,000 new cases and more than 4,000 deaths from cervical cancer will occur in 2013.5 In 2008, over 529,000 new cases of cervical cancer and 275,000 deaths attributed to cervical cancer occurred worldwide, with 86% of the cases in developing countries.6

Cervical cancer is usually treatable, especially when detected early; regular screening with Pap tests is critical for early detection. Guidelines by the U.S. Preventive Services Task Force recommend that women ages 21 to 65 receive a Pap test once every three years.7

However, African American women also have the highest rates of recent pap testing to screen for the disease (81%, compared to 77% of White women and 70% of Asian women).9 Limited access to treatment and early detection, as well as cost, lack of physician referral, and cultural barriers may account for some of these disparities.10

Men are at a much lower risk than women for developing an HPV related cancer and suffer from less than 25% of reported cases.11

Drugs have serious, and sometimes fatal, side effects and too often unintended consequences. But we are sick, and health professionals somehow perform a cost benefit analysis and risk assessment and recommend that we take this drug or that to help us deal with our health condition or else.

Medicine is evolving, medicines are just one variable in a complex medical intervention process and people simply do not behave well or as needed very often.

Like variables that are introduced to repair a broken swiss watch, drugs enter our body system and fix some things yet disturb others.

Medical interventions, as drug therapies, change our blood chemistry and many of the vital functions of our major organs and personal health processes in some way…

As our body systems and organs fail under the weight of heredity, diet, behavior, etc., scientists perform research and through trial and error attempt to produce substances that can be introduced into our sick body systems to address a needed substance or desired cause and effect to make us better.

Our lives and bodies are similar, so research has some success, in a controlled experiment, showing that symptoms can be changed or controlled. However, implementing these medical solutions in the daily routine of our unique yet complex lives is another story.

Diet, exercise and behavior in general are also modified when we become sick and our body changes due to powerful drugs we are advised to take.

As each of us goes through life experiencing disease, we benefit from therapies, if we are “lucky” enough to have access to them, in varying ways.

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